Patient-reported use of collaborative goal setting and glycemic control among patients with diabetes

Lafata, Jennifer Elston; Morris, Heather; Dobie, Elizabeth; Heisler, Michele; Werner, Rachel M.; Dumenci, Lèvent

doi:10.1016/j.pec.2013.01.016

Cited by 68 publications

(54 citation statements)

References 31 publications

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“…For example, SDM may improve patient satisfaction, which over time may lead to trust in the physician, followed by adherence to physician recommendations and ultimately improved health. (73) However, as of yet these relationships remain largely untested in the empirical literature.…”

Section: Discussionmentioning

confidence: 99%

Where Is the Evidence? A Systematic Review of Shared Decision Making and Patient Outcomes

Shay¹,

2014

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Background Despite widespread advocacy for shared decision making (SDM), the empirical evidence regarding its effectiveness to improve patient outcomes has not been systematically reviewed. Purpose To systematically review the empirical evidence linking patient outcomes and SDM, when the decision-making process has been explicitly measured, and to identify under what measurement perspectives SDM is associated with which types of patient outcomes (affective-cognitive, behavioral, and health). Data Sources PubMed (through December 2012) and hand search of article bibliographies. Study Selection Studies were included if they empirically (1) measured SDM in the context of a patient-clinician interaction, and (2) evaluated the relationship between SDM and at least one patient outcome. Data Extraction Study results were categorized by SDM measurement perspective (patient-reported, clinician-reported, or observer-rated) and outcome type (affective-cognitive, behavioral, or health). Data Synthesis Thirty-nine studies met inclusion criteria. Thirty-three used patient-reported measures of SDM, six used observer-rated, and two used clinician-reported. Ninety-seven unique patient outcomes were assessed; 51% affective-cognitive, 28% behavioral, and 21% health. Only 43% of assessments (n=42) found a significant and positive relationship between SDM and the patient outcome. This proportion varied by SDM measurement perspective and outcome category. 52% of outcomes assessed with patient-reported SDM were significant and positive, compared to 21% with observer-rated and 0% with clinician-reported SDM. Regardless of measurement perspective, SDM was most likely to be associated with affective-cognitive patient outcomes (54%), compared to 37% of behavioral, and 25% of health outcomes. Limitations The relatively small number of studies, precludes meta-analysis. The study inclusion and exclusion criteria requiring both an empirical measure of SDM as well as an assessment of the association between that measure and a patient outcome, resulted in most included studies being observational in design. Conclusions SDM, when perceived by patients as occurring, tends to result in improved affective-cognitive outcomes. Evidence is lacking for the association between empirical measures of SDM and patient behavioral and health outcomes.

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Section: Discussionmentioning

confidence: 99%

Where Is the Evidence? A Systematic Review of Shared Decision Making and Patient Outcomes

Shay¹,

2014

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“…42,43 Indeed, in a study of 1065 patients with diabetes, Lafatta et al found that patient-reported use of more collaborative goal setting was associated with greater perceived self-management competency and increased level of trust in the physician ( p <0.05), which in turn were associated with improved glycemic control ( p <0.05). 44 Because high quality primary care is by definition longitudinal, patients and providers also have multiple opportunities over time to identify and address care priorities, and indeed these priorities may change over time as issues are addressed or circumstances change.…”

Section: Methodsmentioning

confidence: 99%

Establishing visit priorities for complex patients: A summary of the literature and conceptual model to guide innovative interventions

et al. 2013

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With the aging of the population and continuing advances in health care, patients seen in the primary care setting are increasingly complex. At the same time, the number of screening and chronic condition management tasks primary care providers are expected to cover during brief primary care office visits has continued to grow. These converging trends mean that there is often not enough time during each visit to address all of the patient’s concerns and needs, a significant barrier to effectively providing patient-centered care. For complex patients, prioritization of which issues to address during a given visit must precede discrete decisions about disease-specific treatment preferences and goals. Negotiating this process of setting priorities represents a major challenge for patient-centered primary care, as patient and provider priorities may not always be aligned. In this review, we present a synthesis of recent research on how patients and providers negotiate the visit process and describe a conceptual model to guide innovative approaches to more effective primary care visits for complex patients based on defining visit priorities. The goal of this model is to inform interventions that maximize the value of available time during the primary care encounter by facilitating communication between a prepared patient who has had time before the visit to identify his/her priorities and an informed provider who is aware of the patient’s care priorities at the beginning of the visit. We conclude with a discussion of key questions that should guide future research and intervention development in this area.

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“…Previous studies have found that patient reports of collaborative goal setting with healthcare providers are associated with increased perceived self-management competence1–3 and trust in their physician 14 Patient reports of engaging in collaborative goal setting have also been found to be associated with improved self-management behaviors and health outcomes, including improvements in Hemoglobin (Hb) A1c and blood pressure levels among patients with diabetes and hypertension 1…”

Section: Introductionmentioning

confidence: 99%

Development and validation of an instrument to measure collaborative goal setting in the care of patients with diabetes

Morris

Dumenci

Lafata

2017

BMJ Open Diab Res Care

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ObjectiveDespite known benefits of patient-perceived collaborative goal setting, we have a limited ability to monitor this process in practice. We developed the Patient Measure of Collaborative Goal Setting (PM-CGS) to evaluate the use of collaborative goal setting from the patient's perspective.Research design and methodsA random sample of 400 patients aged 40 years or older, receiving diabetes care from the Virginia Commonwealth University Health System between 8/2012 and 8/2013, were mailed a survey containing potential PM-CGS items (n=44) as well as measures of patient demographics, perceived self-management competence, trust in their physician, and self-management behaviors. Confirmatory factor analysis was used to evaluate construct validity. External validity was evaluated via a structural equation model (SEM) that tested the association of the PM-CGS with self-management behaviors. The direct and two mediated (via trust and self-efficacy) pathways were tested.ResultsA total of 259 patients responded to the survey (64% response rate), of which 192 were eligible for inclusion. Results from the factor analysis supported a 37-item measure of patient-perceived CGS spanning five domains: listen and learn; share ideas; caring relationship; measurable objective; and goal achievement support (χ=4366.13, p<0.001; RMSEA=0.08). Results from the SEM supported the external validity of the PM-CGS. The relationship between CGS and self-management was partially mediated by perceived competence (p<0.05). The direct effect between the PM-CGS and self-management was significant (p<0.001).ConclusionsCGS can be validly measured by the 37-item PM-CGS. Use of the PM-CGS can help illustrate actionable deficits in goal-setting discussions.

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Patient-reported use of collaborative goal setting and glycemic control among patients with diabetes

Cited by 68 publications

References 31 publications

Where Is the Evidence? A Systematic Review of Shared Decision Making and Patient Outcomes

Where Is the Evidence? A Systematic Review of Shared Decision Making and Patient Outcomes

Establishing visit priorities for complex patients: A summary of the literature and conceptual model to guide innovative interventions

Development and validation of an instrument to measure collaborative goal setting in the care of patients with diabetes

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